Dean Daniel M, Ho Bryant S, Lin Albert, Fuchs Daniel, Ochenjele George, Merk Bradley, Kadakia Anish R
1 Department of Orthopaedic Surgery, Medstar Georgetown University Hospital, Washington, DC, USA.
2 Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Foot Ankle Int. 2017 May;38(5):496-501. doi: 10.1177/1071100716688176. Epub 2017 Jan 19.
Risk factors associated with short-term functional outcomes in patients with operative ankle fractures have been established. However, no previous studies have reported the association between these risk factors and functional outcomes outside of the first postoperative year. We identified predictors of functional and pain outcomes in patients with operative ankle fractures using the Patient Reported Outcomes Measurement System (PROMIS) physical function (PF) and pain interference (PI) measures.
We retrospectively reviewed a multicenter cohort of patients ≥18 years old who underwent operative management of closed ankle fractures from 2001 to 2013 with a minimum of a 2-year follow-up. Patients with pilon variants, Maisonneuve fractures, Charcot arthropathy, prior ankle surgery, and chronic ankle fractures were excluded. Patients meeting inclusion criteria were contacted and evaluated using the PROMIS PF and PI computerized adaptive tests. Patient demographic and injury characteristics were obtained through a retrospective chart review. Univariate and multivariate regression models were developed to determine independent predictors of physical function and pain at follow-up. Included in this study were 142 patients (64 women, 78 men) with a mean age of 52.7 years (SD = 14.7) averaging 6.3 years of follow-up (range 2-14).
Patients had a mean PF of 51.9 (SD = 10.0) and a mean PI of 47.8 (SD = 8.45). Multivariate analysis demonstrated that independent predictors of decreased PF included higher age (B = 0.16, P = .03), higher American Society of Anesthesiologists (ASA) class (B = 10.3, P < .01), and higher body mass index (BMI; B = 0.44, P < .01). Predictors of increased PI included higher ASA class (B = 11.5, P < .01) and lower BMI (B = 0.41, P < .01).
At follow-up, increased ASA class, increased BMI, and higher age at time of surgery were independently predictive of decreased physical function. Factors that were associated with increased pain at follow-up include lower BMI and higher ASA class. ASA class had the strongest effect on both physical function and pain.
Level IV, case series.
与手术治疗的踝关节骨折患者短期功能结局相关的危险因素已明确。然而，既往尚无研究报道这些危险因素与术后第一年之外的功能结局之间的关联。我们使用患者报告结局测量系统（PROMIS）的身体功能（PF）和疼痛干扰（PI）指标，确定手术治疗的踝关节骨折患者功能和疼痛结局的预测因素。
我们回顾性分析了一个多中心队列，该队列纳入了2001年至2013年接受闭合性踝关节骨折手术治疗且至少随访2年的18岁及以上患者。排除有pilon变异型骨折、 Maisonneuve骨折、夏科氏关节病、既往踝关节手术史和陈旧性踝关节骨折的患者。符合纳入标准的患者通过PROMIS PF和PI计算机自适应测试进行联系和评估。通过回顾性病历审查获取患者的人口统计学和损伤特征。建立单因素和多因素回归模型，以确定随访时身体功能和疼痛的独立预测因素。本研究纳入142例患者（64例女性，78例男性），平均年龄52.7岁（标准差=14.7），平均随访6.3年（范围2 - 14年）。
患者的平均PF为51.9（标准差=10.0），平均PI为47.8（标准差=8.45）。多因素分析表明，PF降低的独立预测因素包括年龄较大（B = 0.16，P = 0.03）、美国麻醉医师协会（ASA）分级较高（B = 10.3，P < 0.01）和体重指数（BMI）较高（B = 0.44，P < 0.01）。PI增加的预测因素包括ASA分级较高（B = 11.5，P < 0.01）和BMI较低（B = 0.41，P < 0.01）。
随访时，ASA分级增加、BMI增加和手术时年龄较大是身体功能降低的独立预测因素。与随访时疼痛增加相关的因素包括BMI较低和ASA分级较高。ASA分级对身体功能和疼痛的影响最强。
IV级，病例系列。
